Renerus J. Stolwyk

Increases in high-amplitude, low-frequency EEG oscillations during non-rapid eye movement (NREM) sleep serve as markers of neuronal silencing, which disrupts functional connectivity and is associated with a loss of awareness and responsiveness. Cortical slowing likewise occurs during wakefulness, upon sleep deprivation, and accompanies performance deterioration. Recent work has revealed similar oscillations (termed ‘sleep-like slow waves’) following stroke in brain regions close or connected to a brain lesion, offering a plausible but untested mechanism for stroke-related behavioural impairment. Here, we simultaneously recorded EEG and behavioural performance while 30 unilateral stroke patients (12 left hemisphere, 18 right hemisphere) and 27 age-matched healthy adults completed a computerised perceptual decision-making task. Stroke patients had predominantly middle cerebral artery strokes (n=25), with a small subset of posterior cerebral artery (n=4), and anterior cerebral artery/middle cerebral artery (n=1) lesions. Sleep-like slow waves occurred more frequently in stroke patients relative to healthy controls, with limited spatial specificity when comparing patients with left and right lesion sites (more slow waves ipsilateral of the lesion). Furthermore, there was a significant correlation between slow wave occurrence and the accuracy and speed of perceptual reports in stroke patients, suggesting that variations in the occurrence of slow waves may contribute to cognitive heterogeneity post-stroke. As sleep-like slow waves predict deficits in perceptual decision-making following stroke, they represent a plausible mechanism of post-lesion functional network dysfunction extending beyond the damaged regions, thereby contributing to broader cognitive impairments.

Cognitive impairment is a key consequence of small vessel disease (SVD), yet prior work has often dichotomised cognitive outcomes as either intact or impaired, obscuring domain- and severity-specific effects. We conducted three-level random-effects meta-analyses to examine cognitive performance across multiple cognitive domains and levels of SVD severity. A total of 24 studies met the inclusion criteria, of which 16 provided sufficient group summary data of White Matter Hyperintensity (WMH) pathology for quantitative synthesis. The remaining studies contributed to descriptive analyses, which synthesised broader SVD pathology types. Processing speed showed the earliest and strongest deficits, with small effects at low WMH burden and medium-to-large effects by high WHM burden, Fazekas 3 (Fazekas 3 pooled g = − 1.02, 95% CI [− 1.46, − 0.58]). Executive function deficits emerged at moderate-to-severe stages and were large by Fazekas 3 (Fazekas 3 g = − 1.11, 95% CI [− 1.53, − 0.69]); attention/working memory estimates trended in the expected direction but did not reach significant effects at any Fazekas level, reflecting the small number of contributing studies. In contrast to processing speed and executive function, verbal and visual memory showed small effects at low burden that reached large by Fazekas 3, while confrontation naming effects remained small-to-medium across severity levels and general intelligence did not differ significantly from controls at any level. Between- and within-study variance components indicated substantial residual heterogeneity across several cognitive domains. Together, the meta-analytic and descriptive findings provide converging evidence that reduced processing speed is an early marker of SVD-related cognitive change, with broader deficits emerging at greater severity. Collectively, these findings provide further insights into the cognitive profile of SVD and underscore the need for additional research, particularly across SVD pathologies beyond WMH.

Addressing memory problems post-stroke is a priority, given the high prevalence of memory problems [1], their impact on activity, participation and quality of life [2,3], and the high unmet need fo...

Clinical neuropsychology training institutions face the challenge of providing up-to-date instruction on rapidly evolving healthcare innovations, including teleneuropsychology (teleNP). This study explored the training needs, priorities, and preferences of Australian clinical neuropsychology trainees and supervisors to inform future training. An exploratory qualitative design was employed. Semi-structured interviews were conducted with 13 postgraduate neuropsychology trainees and 11 supervisors. Data were analyzed using reflexive thematic analysis. Four broad themes and four subthemes were generated: (1) initial disruption evolved into confidence with practice; (2a) knowledge and skill gaps and (2b) practice considerations; (3) building competence through structured learning and practice resources; (4a) teleNP training needs and (4b) competencies. In early-stage teleNP implementation, a lack of formal training led to high levels of anxiety which interfered with learning. Adjustment was supported by a collaborative “learning together” process that leveraged the variable technical and clinical skills of each party. Trainees sought observational and practical learning, while supervisors provided scaffolded training, progressing from foundational skills to simulated teleNP practice. Overall, both groups believed teleNP training should be embedded within postgraduate training. Seven training considerations and 11 teleNP competencies are proposed, derived through integration with the extant literature, to guide future implementation. The findings support the need for structured, competency-based teleNP training to be embedded early within clinical neuropsychology education. Such training aligns with emerging competency frameworks, prepares trainees to provide safe, ethical services, and supports efforts to improve healthcare access.

BACKGROUND The continuing rise in dementia diagnoses, combined with limited growth in the clinical workforce, necessitates more efficient and accessible methods of cognitive assessment. While technological developments have allowed clinicians to deliver assessment services via telehealth, current uses, barriers, and enablers to telehealth assessment in Australia are not well understood. OBJECTIVE This study aimed to explore clinician experiences and opinions, including barriers and enablers, of conducting cognitive assessment via telehealth with middle-to-older aged adults in Australia. METHODS An online quantitative survey was distributed to clinicians with prior experience of providing cognitive assessments with middle-to-older aged adults. A subsample of survey respondents also participated in an online semi-structured interview. Respondent characteristics and quantitative data were analysed using descriptive statistics. Qualitative interview data were analysed using applied thematic analysis and results mapped to the domains of the COM-B framework (capability, opportunity and motivation). RESULTS Survey responses (n=88) were received from psychologists (56%), specialist doctors (20%), primary health clinicians (16%) and other allied health professionals (8%). A majority (88%) had some telehealth experience, with almost half (44%) using it weekly or more. Most common reasons for using telehealth included patient preferences, reduced travel and infection risk, and increased work flexibility and economic savings. The main barriers included the need for a patient support person, as well as technological issues. Most respondents (63%) had also administered a cognitive assessment via telehealth. Clinician confidence in the results obtained via a telehealth assessment were generally high; in particular, confidence was significantly higher for psychologists and those with previous cognitive assessment via telehealth experience (P<.001). Qualitative analysis resulted (n=20) in three themes mapped to the COM-B framework: 1. clinician telehealth skills and patient digital competency (capability); 2. suitability of cognitive tests, patient’s testing environment, technology and social support (opportunity); and 3. clinician opinions and approach to practice (motivation). Specific enablers and barriers within each theme were explored in greater detail. CONCLUSIONS Despite current barriers, clinicians across health disciplines described several factors that can support more frequent and effective use of telehealth-based assessment. Practical recommendations are provided as a scaffold to increase clinician and patient capacity, as well as cognitive test validation, intending to facilitate effective and appropriate utilisation of cognitive assessment via telehealth. Addressing these factors can help ensure cognitive assessments for middle-to-older aged adults are more accessible while meeting clinical standards in the assessment and diagnosis of dementia. CLINICALTRIAL NA

Ongoing memory impairment is commonly associated with neurological conditions, such as epilepsy (Tedrus et al., 2021), as well as following ABI, including stroke and traumatic brain injury (Jokinen...

Background: Managing physiological risk factors (blood pressure, lipids, stress, blood glucose) post-stroke is essential yet challenging. In this sub-study of a feasibility randomized controlled trial, we examined changes in these parameters following a stroke-tailored mindfulness-based intervention (MBI) compared with an attention control. Methods: Participants 3–18 months post-stroke were recruited from the Australian Stroke Clinical Registry (May 2021–July 2023) and randomized 1:1 to a 12-week MBI (weekly yoga + ≥3 home meditation sessions) or attention control (education and peer support). All attended weekly 60-min classes. Outcomes included blood pressure and stress (perceived stress scale, hair cortisol). A sub-group (n = 17) also had HbA1c and lipid profile assessed. Descriptive statistics, within-group effect sizes (Cohen’s d), and generalized linear modeling were used. Results: A total of 38 participants were randomized with 36 participants completing the trial (mean age 69 years; 72% male), and the MBI group showed greater within-group improvements in blood pressure, with clinically meaningful reductions in systolic (5 mmHg; d = 0.35) and diastolic (4 mmHg; d = 0.41) values, compared to smaller effects in the control group. Exploratory trends suggested favorable change in lipid profiles (HDL and LDL) in the MBI group, while triglycerides improved in the control group. No changes were observed for HbA1c. Stress markers, including hair cortisol, showed positive trends in the MBI group (d = 0.52). No significant between-group differences were detected. Conclusions: This sub-study of a well-designed, rigorous feasibility trial provides preliminary findings of clinically meaningful differences in blood pressure and lipid profiles in the MBI group. The findings support the potential of MBIs in managing post-stroke cardiovascular risk factors and warrant larger trials to confirm these preliminary effects.

To assess characteristics of individuals who wanted to address mental health needs during hospital admission for stroke through structured, person-centered goal setting, and to describe the types of mental health-related goals. Analysis of aggregated baseline data from a randomized controlled trial (Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke). Trial participants were recruited from 11 Australian hospitals. Within 10 days of stroke admission, participants selected two to five recovery goals from five categories (health, mind and body, everyday activities, out-and-about, and health care). Baseline data included demographics, anxiety/depression status, health-related quality of life, unmet needs, and self-efficacy after stroke. Characteristics associated with selecting mental health-related goals were determined using multivariable logistic regressions. Among 465 participants (33% female, Mdn = 67 years), 50 (11%) selected a mental health-related goal. Content of most mental health-related goals focused on improving mental health (73%) and controlling another lifestyle factor (20%). Selection of mental health-related goals was associated with being under 65 years of age, OR = 2.1, 95% confidence interval (CI) = [1.1, 3.9]; history of mental health concerns, OR = 4.7, 95% CI = [2.5, 8.9]; elevated symptoms of depression or anxiety, OR = 6.6, 95% CI = [3.3, 13.0]; or reporting an unmet mental health need, OR = 5.5, 95% CI = [2.7, 10.9]. We highlight important characteristics associated with self-selecting mental health-related goals after stroke. Greater understanding of barriers for older individuals and those with elevated symptoms of depression/anxiety setting mental health-related goals is warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).